This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Monday, 27 April 2009

The Matron who actually worked a shift

I can barely type this or drink my coffee because I am laughing so hard. I did hear this secondhand. I have seen similar situations first hand and I have no doubt that the following occurred.

Let's set the scene. Not my hospital but I wish it was. Really I do. I would have had fun with this. A certain very large very acute medical ward at a hospital nearby with 30 beds was short one RN for the shift. This left one RN for 30 patients. She kicked off and their highly paid and god knows what she actually does Matron got roped in to work an 8 hour evening shift.

So Matron was to have 15 patients and the other RN was to have 15. It takes forever to do a drug round for 15 patients, let alone 30. So each nurse takes a side in order to maximise the chances of patients getting their medications on time and reducing the amount of errors. Once you finish your drug round (after about 2 hours)you are pretty much locked into being the primary nurse for that side only and you really are not up to date about the other side. That is why nurses have "sides".

Now keep in mind that highly paid modern Matrons never come near the wards. Ever. This is the case even when we are in way over our ears and we actually beg. If a mistake occurs they rip you apart....you get this mock trial thing where they all sit around you and destroy your character like high level judges in a kangaroo court. And you are guilty until proven innocent. If you really are innocent and just outspoken they will make something up to punish you for rocking the medical shitboat. I am surprised that they don't give them wigs, robes, gavels and iron maidens.

How this matron got roped in I don't know but she agreed to work a late shift.

When she arrived on the ward she informed the ward registered nurse that was going to be on duty with her that: "I will be working as an HCA because I have been away from nursing too long". Remember that today's matrons may be qualified nurses from a long time ago but really they are an extension of management rather than nursing staff. They are focused on management aims and goals.

The ward nurse wasn't having this. The matron has something like double the ward nurse's salary. She knew that it is impossible to be a primary nurse and do all drugs, interventions, and assessments for 30 acute medical patients. Matron had to take a side.

Andy by 9PM when night staff came in Matron was at the nurse's station in tears. "This is impossible, this is impossible" "This is ridiculous". "There's not enough time". "The interruptions are constant and unending" Blubber blubber blubber.

Really, Matron. No shit. Why don't you get your ass down to the ward a bit more often?

She gave a fractured and weak handover to the night staff and left. She really had no idea what was going on with her patients. Night staff said that there were so many unsigned for/ not given drugs on her side that it wasn't even funny. Nothing got done. It was like she just gave up.

The nurse who worked with her said that at mealtime she brought a diabetic patient some chocolate cake and nearly gave a confused who was on clear free fluids and plate of chips. She just couldn't keep up with it all. The drugs that got given were given late. A few warfarins and IV antibiotics were missed totally. It took nightshift the first few hours of their shift to sort out all the problems.

No wonder Matrons don't come near the wards. This one never came back to do a shift. They are not completely stupid you know.

LMAO! Maybe she will have a little more compassion with the real nurses! And maybe tell admin how difficult her night was. Hope it happens to more of these matrons! Kudos to the nurse who put her foot down about not taking 30 patients. Good for her!

Doesn't the NMC Code have something to say about such nonsense practice? I wouldn't have thought the NMC would like such a matron to leave her ivory tower and pretend to cut is as a proper nurse, for a while, and compromise patient care in the process . . .

I don't know if I would have let one of ours do a shift on the ward. These older trained nurses who haven't been on a ward since 1981 scare me. They are dangerous in today's ward environment without any further education.

Thus, are they competent? Are they working within the NMC Code of Conduct if undertaking such clinical duties that they're woefully shabby at? * You must have the knowledge and skills for safe and effective practice when working without direct supervision * You must recognise and work within the limits of your competence * You must take part in appropriate learning and practice activities that maintain and develop your competence and performance

This reminds me of an experience I had during one of my first shifts as a new A&E nurse. Due to being short staffed I'd been left alone in resus with a patient (stable but post-ictal).

I was getting a bit anxious because the doctor was prescribing IV meds which i needed to calculate and draw up with another RN for checking/safety purposes - and there was only me.

Imagine my relief when i glanced through the open resus doors to see Matron walking past...and...she was in uniform!

(This was rare in itself - the nurses used to joke that she only wore her uniform for the X amount of "clinical" days required by the NMC to maintain registration)

Anyway, I called to her to ask her to check the IV dose/calulation/preparation with me. Well she clearly nearly died, she was flustered and agitated, and openly admitted that she hadn't got a clue, that it had been so long, and that she would just take my word for it and trust me.

She signed her signature to the infusion without even going through it with me, and left.

Wow! In the USA I believe you have to spend so many hours on the floor per year to keep your registration current. Is this not the case in the UK also? I know certain management RNs that never actually do go on the floor but seem to keep their registration current. It's great that you started up your blog again Anne, I stopped reading sometime last year when you stopped posting - Thanks.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.